Provider Demographics
NPI:1477732899
Name:GURINDER S. DHILLON M D PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GURINDER S. DHILLON M D PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-423-2510
Mailing Address - Street 1:1525 WEBSTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4935
Mailing Address - Country:US
Mailing Address - Phone:707-423-2510
Mailing Address - Fax:707-425-4236
Practice Address - Street 1:1525 WEBSTER ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4935
Practice Address - Country:US
Practice Address - Phone:707-423-2506
Practice Address - Fax:707-429-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28045ZMedicare PIN